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PERMIT TO C ONNEC;'''
Tigard Saz;tary District
PERMIT IVB' 1180 DATE
PERMIT IS GIVEN TO �r ------
OF _ �__ -- ----
TO CONNE(_'T A ��__ --------
TO THE QYSTEM OF TIGARD SANITARY DISTRICT
AT_
TRIS PERMIT MUST BE POSTED ON THE DESCRIBED PREMISES UNTIL CON-
NECTION IS MADE AND INSPECT19N OF CONNECTION HAS BEEN COM-
PLETED. AA
PERMIT FEE PAID 41— ..� '. TIGARD SANITARY DISTRICT �
By
CONNECj'[ON INSPECTED AND APPROVED
Date — — ---- -----— uperintendent
I �
Address / / 3 � �� Q Permit No.--/J
Permit charge 2.
Owner ��e � , t� Connection fee 2..!V --
Paid by--aZA.,,,K __ _.-
Tyre of Building Le pate connected
Service Rate _ _ j'nspection fee_a_
Contractor. Paia by
Size of connection_ . �' As•.3essment� ,Paid `�`_